When I was pregnant nineteen years ago I wish my doctor had warned me I might be at risk for postpartum depression.
Her words wouldn’t have freaked me out, they would have helped me cope when the darkness did indeed hit.
I wish during my 6 week check-up (when I was at my private worst) my Ob-Gyn had handed me a mental health screening and even if I lied on every question, she still explained how the “baby blues” are different than depression.
In January for the first time the United States Preventive Services Task Force recommended screening pregnant and postpartum women for maternal mental illness.
Hopefully now more health care practitioners will talk to women so those who suffer know they’re not bad people or rotten mothers or God knows, alone.
The fact is worldwide 10% of pregnant women and 13% of postpartum women have a mental disorder and the numbers are even higher in developing countries.
While maternal mental illness is often lumped into the catchall “postpartum depression” it’s more complicated than a single kitchen sink diagnosis.
Symptoms can show up during pregnancy or long after birth and they don’t always look like depression, sometimes they look like:
• Anxiety
• Panic disorder
• Post-traumatic stress disorder
• Obsessive compulsive disorder
• Psychosis
Alone, or in combination.
Mental illness has always been stigmatized but especially inside the idealized institution of motherhood where pretending superhuman resilience to change, sleep deprivation, anger, frustration, fear, anxiety and sadness awards women the coveted “best” mother prize…. http://www.huffingtonpost.com/laura-g-owens/maternal-mental-health-screening_b_9485446.html

The timing of a pregnancy should include diagnosis of potential maternal mental health issues and what treatment may be necessary.

The use of antidepressants has been on the rise for many years. Between 2 and 8% of pregnant women are on antidepressants. Now researchers from the National Centre for Register-based Research at Aarhus BSS show that there is an increased risk involved in using antidepressants during pregnancy.
The researchers, headed by Xiaoqin Liu, have applied register-based research to the study of 905,383 children born between 1998 and 2012 with the aim of exploring the possible adverse effects of the mother’s use of antidepressants during her pregnancy.
They found that out of the 905,383 children in total, 32,400 developed a psychiatric disorder later in life. Some of these children were born to mothers who were on antidepressants during their pregnancy, while other children had not been exposed to medication.
“When we look at children born to mothers who discontinued and continued antidepressant treatment during pregnancy, we can see an increased risk of developing a psychiatric disorder if the mothers continued antidepressant treatment while pregnant,” says Xiaoqin Liu, who is the lead author of the article, which has just been published in BMJ-British Medical Journal.
More specifically, the researchers divided the children into four groups depending on the mother’s use of antidepressants before and during pregnancy. The children in group 1 had not been exposed to antidepressants in the womb. In group 2, the mothers had been taking antidepressants up until the pregnancy, but not during. In group 3, the mothers were using antidepressants both before and during the pregnancy. Group 4 consisted of children, whose mothers were new users of antidepressants and had started taking the medication during the pregnancy.
The result of the study showed an increased number of children with psychiatric disorders in the group in which the mothers had been using antidepressants during their pregnancy. Approximately twice as many children were diagnosed with a psychiatric disorder in group 4 (14.5%) than in group 1 (8%). In groups 2 and 3 respectively, 11.5% and 13.6% were diagnosed with a psychiatric disorder at age 16 years.
Psychiatric disorders are hereditary
In their analyses, the researchers took into account that heritability also plays a part in determining who will be diagnosed with a psychiatric disorder, and that it is not just a question of being exposed to antidepressants in the womb…. https://www.sciencedaily.com/releases/2017/09/170907112400.htm

Citation:

Using antidepressants during pregnancy may affect your child’s mental health
Date: September 7, 2017
Source: Aarhus University
Summary:
The use of antidepressants during pregnancy increases the risk of your child being diagnosed with a psychiatric disorder later in life, a study of almost one million Danish children shows. However, heritability also plays a part, according to the researchers.
Journal Reference:
1. Xiaoqin Liu, Esben Agerbo, Katja G Ingstrup, Katherine Musliner, Samantha Meltzer-Brody, Veerle Bergink, Trine Munk-Olsen. Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ, 2017; j3668 DOI: 10.1136/bmj.j3668

Here is the press release from Aarhus University:

Using antidepressants during pregnancy may affect your child’s mental health
A study from Aarhus BSS of almost one million Danish children shows that the use of antidepressants during pregnancy increases the risk of your child being diagnosed with a psychiatric disorder later in life. However, heritability also plays a part, according to the researchers.
2017.09.07 | Ingrid Marie Fossum
The use of antidepressants has been on the rise for many years. Between 2 and 8% of pregnant women are on antidepressants. Now researchers from the National Centre for Register-based Research at Aarhus BSS show that there is an increased risk involved in using antidepressants during pregnancy.
The researchers, headed by Xiaoqin Liu, have applied register-based research to the study of 905,383 children born between 1998 and 2012 with the aim of exploring the possible adverse effects of the mother’s use of antidepressants during her pregnancy.
They found that out of the 905,383 children in total, 32,400 developed a psychiatric disorder later in life. Some of these children were born to mothers who were on antidepressants during their pregnancy, while other children had not been exposed to medication.
“When we look at children born to mothers who discontinued and continued antidepressant treatment during pregnancy, we can see an increased risk of developing a psychiatric disorder if the mothers continued antidepressant treatment while pregnant,” says Xiaoqin Liu, who is the lead author of the article, which has just been published in BMJ-British Medical Journal.
More specifically, the researchers divided the children into four groups depending on the mother’s use of antidepressants before and during pregnancy. The children in group 1 had not been exposed to antidepressants in the womb. In group 2, the mothers had been taking antidepressants up until the pregnancy, but not during. In group 3, the mothers were using antidepressants both before and during the pregnancy. Group 4 consisted of children, whose mothers were new users of antidepressants and had started taking the medication during the pregnancy.
The result of the study showed an increased number of children with psychiatric disorders in the group in which the mothers had been using antidepressants during their pregnancy. Approximately twice as many children were diagnosed with a psychiatric disorder in group 4 (14.5%) than in group 1 (8%). In groups 2 and 3 respectively, 11.5% and 13.6% were diagnosed with a psychiatric disorder at age 16 years.
Psychiatric disorders are hereditary
In their analyses, the researchers took into account that heritability also plays a part in determining who will be diagnosed with a psychiatric disorder, and that it is not just a question of being exposed to antidepressants in the womb.
“We chose to conduct the study on the assumption that psychiatric disorders are highly heritable. For this reason, we wanted to show that is too narrow if you only look at autism, which is what many previous studies have done. If heritability plays a part, other psychiatric disorders such as depression, anxiety, ADHD-like symptoms would also appear in the data,” says Trine Munk-Olsen, who is also one of the researchers behind the study.
Indeed, the study also shows that the increase covers not only autism but also other psychiatric disorders such as depression, anxiety, and ADHD. Thus it becomes clear that the mother’s underlying psychiatric disorder matters in relation to the child’s mental health later in life. At the same time, it cannot be ruled out that the use of antidepressants further increases the risk of psychiatric diseases in the child.
“Our research shows that medication seems to increase the risk, but that heritability also plays a part,” says Trine Munk-Olsen, who also points out that it might be the mothers who suffer from the most severe forms of depression who need to take medication during their pregnancy.
Not just black and white
The researchers hope that the study can increase the focus on the fact that the research results are not just black and white. This could help doctors advise women on the use of antidepressants both before and after their pregnancy. Some women might be able to discontinue treatment with the medication while pregnant. However, the researchers also acknowledge that some women need medication and stress that the consequences of an untreated depression are severe and can lead to serious consequences to both mother and child.
The most important message is that we ensure and safeguard the mental well-being of the pregnant women, and for some women, this involves the use of antidepressants.
“These women should not feel guilty about taking antidepressants. Even though there is an increased risk of the child developing a psychiatric disorder later in life, our research shows that we cannot blame medication alone. Heritability also plays a part,” says Trine Munk-Olsen.
Facts:
• The article “Antidepressant use during pregnancy and psychiatric disorders in the offspring: A Danish nationwide register-based cohort study” has been published in the medical journal BMJ-British Medical Journal.
• The research has been conducted by researchers at the National Centre for Register-based Research at Aarhus BSS in collaboration with an American and a Dutch psychiatrist.
• The research has been partly funded by The Lundbeck Foundation Initiative for Integrative Psychiatric Research”- iPSYCH, as well as the National Institute of Mental Health (NIMH) (R01MH104468)
• The study includes all children born in Denmark between 1998 and 2012. The study followed the children until 2014, where some of the children were 16,5 years old.
Further info:
Trine Munk-Olsen
Senior Researcher
National Centre for Register-based Research
Aarhus BSS, Aarhus University
tmo@econ.au.dk
+45 87165749 / + 45 51505161
¬Xiaoqin Liu
Postdoc
National Centre for Register-based Research
Aarhus BSS, Aarhus University
lxq@econ.au.dk
+45 87165358

Children will have the most success in school, if they are ready to learn. Ready to learn includes proper nutrition for a healthy body and the optimum situation for children is a healthy family. Many of societies’ problems would be lessened if the goal was a healthy child in a healthy family.

People of all ages may have feelings of profound sadness, loss, and depression. There is no one on earth, despite what the ads attempt to portray, who lives a perfect life. Every life has flaws and blemishes, it is just that some cope better than others. For every person who lives to a ripe old age, during the course of that life they may encounter all types of loss from loss of a loved one through death, divorce or desertion, loss of job, financial reverses, illness, dealing with A-holes and twits, plagues, pestilence, and whatever curse can be thrown at a person. The key is that they lived THROUGH whatever challenges they faced AT THAT MOMENT IN TIME. Woody Allen said something like “90% of life is simply showing up.” Let moi add a corollary, one of the prime elements of a happy life is to realize that whatever moment you are now in, it will not last forever and that includes moments of great challenge. A person does not have to be religious to appreciate the story of Job. The end of the story is that Job is restored. He had to endure much before the final victory, though.

Medical Press reported in the article, High doses of antidepressants appear to increase risk of self-harm in children young adult:

Children and young adults who start antidepressant therapy at high doses, rather than the “modal” [average or typical] prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment.
A previous meta-analysis by the U.S. Food and Drug Administration (FDA) of antidepressant trials suggested that children who received antidepressants had twice the rate of suicidal ideation and behavior than children who were given a placebo. The authors of the current study sought to examine suicidal behavior and antidepressant dose, and whether risk depended on a patient’s age.
The study used data from 162,625 people (between the ages of 10 to 64 years) with depression who started antidepressant treatment with a selective serotonin reuptake inhibitor at modal (the most prescribed doses on average) or at higher than modal doses from 1998 through 2010.
The rate of suicidal behavior (deliberate self-harm or DSH) among children and adults (24 years or younger) who started antidepressant therapy at high doses was about twice as high compared with a matched group of patients who received generally prescribed doses. The authors suggest this corresponds to about one additional event of DSH for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, the difference in risk for suicidal behavior was null. The study does not address why higher doses might lead to higher suicide risk….
“Their findings suggest that higher than modal initial dosing leads to an increased risk for DSH and adds further support to current clinical recommendations to begin treatment with lower antidepressant doses. While initiation at higher than modal doses of antidepressants may be deleterious, this study does not address the effect of dose escalation,” they continue.
“Moreover, while definitive studies on the impact of dose escalation in the face of nonresponse remain to be done, there are promising studies that suggest in certain subgroups, dose escalation can be of benefit. Finally it should be noted that in this study, there was no pre-exposure to post-exposure increase in suicidal behavior after the initiation of antidepressants in youth treated at the modal dosage,” they conclude. http://medicalxpress.com/news/2014-04-high-doses-antidepressants-self-harm-children.html

Citation:

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Original Investigation|April 28, 2014
Antidepressant Dose, Age, and the Risk of Deliberate Self-harm
ONLINE FIRST
Matthew Miller, MD, ScD1; Sonja A. Swanson, ScM2; Deborah Azrael, PhD1; Virginia Pate, PhD, PhD3; Til Stürmer, MD, ScD3
[+] Author Affiliations
JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2014.1053
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ABSTRACT
ABSTRACT | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES
Importance A comprehensive meta-analysis of randomized trial data suggests that suicidal behavior is twice as likely when children and young adults are randomized to antidepressants compared with when they are randomized to placebo. Drug-related risk was not elevated for adults older than 24 years. To our knowledge, no study to date has examined whether the risk of suicidal behavior is related to antidepressant dose, and if so, whether risk depends on a patient’s age.
Objective To assess the risk of deliberate self-harm by antidepressant dose, by age group.
Design, Setting, and Participants This was a propensity score–matched cohort study using population-based health care utilization data from 162 625 US residents with depression ages 10 to 64 years who initiated antidepressant therapy with selective serotonin reuptake inhibitors at modal or at higher than modal doses from January 1, 1998, through December 31, 2010.
Main Outcomes and Measures International Classification of Diseases, Ninth Revision (ICD-9) external cause of injury codes E950.x-E958.x (deliberate self-harm).
Results The rate of deliberate self-harm among children and adults 24 years of age or younger who initiated high-dose therapy was approximately twice as high as among matched patients initiating modal-dose therapy (hazard ratio [HR], 2.2 [95% CI, 1.6-3.0]), corresponding to approximately 1 additional event for every 150 such patients treated with high-dose (instead of modal-dose) therapy. For adults 25 to 64 years of age, the absolute risk of suicidal behavior was far lower and the effective risk difference null (HR, 1.2 [95% CI, 0.8-1.9]).
Conclusions and Relevance Children and young adults initiating therapy with antidepressants at high-therapeutic (rather than modal-therapeutic) doses seem to be at heightened risk of deliberate self-harm. Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that antidepressant dose is generally unrelated to therapeutic efficacy, our findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to closely monitor patients starting antidepressants, especially youth, for several months.

Here is the press release from Harvard:

PUBLIC RELEASE DATE:
28-Apr-2014

Contact: Marge Dwyer
mhdwyer@hsph.harvard.edu
617-432-8416
The JAMA Network Journals
High doses of antidepressants appear to increase risk of self-harm in children young adult
Bottom Line:
Children and young adults who start antidepressant therapy at high doses, rather than the “modal” [average or typical] prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment.
Author:
Matthew Miller, M.D., Sc.D., of the Harvard School of Public Health, Boston, and colleagues.
Background:
A previous meta-analysis by the U.S. Food and Drug Administration (FDA) of antidepressant trials suggested that children who received antidepressants had twice the rate of suicidal ideation and behavior than children who were given a placebo. The authors of the current study sought to examine suicidal behavior and antidepressant dose, and whether risk depended on a patient’s age.
How the Study Was Conducted:
The study used data from 162,625 people (between the ages of 10 to 64 years) with depression who started antidepressant treatment with a selective serotonin reuptake inhibitor at modal (the most prescribed doses on average) or at higher than modal doses from 1998 through 2010.
Results: The rate of suicidal behavior (deliberate self-harm or DSH) among children and adults (24 years or younger) who started antidepressant therapy at high doses was about twice as high compared with a matched group of patients who received generally prescribed doses. The authors suggest this corresponds to about one additional event of DSH for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, the difference in risk for suicidal behavior was null. The study does not address why higher doses might lead to higher suicide risk.
Discussion: “Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that dose is generally unrelated to the therapeutic efficacy of antidepressants, our findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to monitor all patients starting antidepressants, especially youth, for several months and regardless of history of DSH.”
(JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2014.1053. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note: Authors made a conflict of interest and funding disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Initial Dose of Antidepressants, Suicidal Behavior in Youth
In a related commentary, David A. Brent, M.D., of the University of Pittsburgh, and Robert Gibbons, Ph.D., of the University of Chicago, write: “In summary Miller et al are to be commended on a thoughtful and careful analysis of the effects of initiating antidepressants at higher than modal doses.”
“Their findings suggest that higher than modal initial dosing leads to an increased risk for DSH and adds further support to current clinical recommendations to begin treatment with lower antidepressant doses. While initiation at higher than modal doses of antidepressants may be deleterious, this study does not address the effect of dose escalation,” they continue.
“Moreover, while definitive studies on the impact of dose escalation in the face of nonresponse remain to be done, there are promising studies that suggest in certain subgroups, dose escalation can be of benefit. Finally it should be noted that in this study, there was no pre-exposure to post-exposure increase in suicidal behavior after the initiation of antidepressants in youth treated at the modal dosage,” they conclude.
(JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2013.14016. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note: Authors made conflict of interest and funding disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
###
Media Advisory:
To contact author Matthew Miller, M.D., Sc.D., call Marge Dwyer at 617-432-8416 or email mhdwyer@hsph.harvard.edu. To contact commentary author David A. Brent, M.D., call Gloria Kreps at 412-586-9764 or email krepsga@upmc.edu.